Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Albertus Magnus University, Cologne, Germany,
Int Orthop. 2014 Apr;38(4):847-55. doi: 10.1007/s00264-013-2208-7. Epub 2013 Dec 12.
The tension band wiring (TBW) technique is a common treatment for the fixation of olecranon fractures with up to three fragments. The literature and surgeons describe TBW as an uncomplicated, always available and convenient operation producing excellent results. The purpose of this study was to determine whether TBW is more ambitious than believed or the procedure provides an increased level of tolerance concerning the surgical technique.
This study reviewed 239 TBW cases in patients with olecranon fractures or osteotomies. We reviewed a total of 2,252 X-rays for ten operative imperfections: (1) nonparallel K-wires, (2) long K-wires, (3) K-wires extending radially outwards, (4) insufficient fixation of the proximal ends of the K-wires, (5) intramedullary K-wires, (6) perforation of the joint surface, (7) single wire knot, (8) jutting wire knot(s), (9) loose figure-of-eight configuration, and (10) incorrect repositioning.
On average, there were 4.24 imperfections per intervention in the cases reviewed. A total of 1,014 of 2,390 possible imperfections were detected. The most frequent imperfections were insufficient fixation of the proximal ends of the K-wires (91% of all cases), the use of a single wire knot (78%) and nonparallel K-wires (72%). Mayo IIa (n = 188) was the most common fracture type.
Our results and the number of complications described by the literature together support the conclusion that TBW is not as easy as surgeons and the literature suggest. Although bone healing and the functional results of TBW are excellent in most cases, the challenges associated with this operation are underestimated.
IV, treatment study.
张力带钢丝固定（TBW）技术是一种常见的治疗三部分骨折的方法。文献和外科医生描述 TBW 是一种简单、随时可用且方便的手术，可产生出色的结果。本研究旨在确定 TBW 是否比人们想象的更具野心，或者该手术是否提供了更高水平的手术技术容忍度。
本研究回顾了 239 例接受鹰嘴骨折或截骨术的患者的 TBW 病例。我们总共审查了 2252 张 X 光片，以确定十种手术缺陷：（1）钢丝不平行，（2）钢丝过长，（3）钢丝向外侧放射状突出，（4）钢丝近端固定不充分，（5）髓内钢丝，（6）关节面穿孔，（7）单根钢丝结，（8）突出的钢丝结，（9）松脱的 8 字形结构，以及（10）复位不正确。
在审查的病例中，平均每个干预措施有 4.24 个缺陷。总共发现了 2390 个可能的缺陷中的 1014 个。最常见的缺陷是钢丝近端固定不充分（所有病例的 91%）、使用单根钢丝结（78%）和钢丝不平行（72%）。Mayo IIa（n=188）是最常见的骨折类型。
我们的结果和文献中描述的并发症数量共同支持这样的结论，即 TBW 并不像外科医生和文献所描述的那样简单。尽管在大多数情况下，TBW 的骨愈合和功能结果都很好，但该手术的挑战被低估了。
IV，治疗研究。
